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Video Fluoroscopy

Video Fluoroscopy is a means of studying the motion of joints of the body and recording the results of that motion on video tape. The process of fluoroscopy has been around since the early 1900s when it was used to examine bones and soft tissue and to some degree motion. Some years ago a shoe manufacturer used fluoroscopy to show people how their feet were fitting in their shoes. Utilization by the medical profession was intensified when it was discovered that fluids flowing through organs with special dyes could be monitored with fluoroscopy. This technique has been improved with the invention of equipment that is more efficient than those early days when it was more of a fad.

Now, fluoroscopy is an accepted procedure for chiropractic as well as the medical profession. The most distinct difference is that chiropractors use the procedure to study the movement of joints in the body. The most prominent structures studied are in the cervical and lumbar spine, as well as joints of the extremities.

One of the most dramatic improvements in recent years has been the image intensifier tubes that convert the beam of energy into the video image that is sent to the video recorder. These recorded images then make it possible for the doctor to play the motion over and over and determine where the spinal segments are not moving properly.

Radiation is reduced by lower "kvp" and "ma" settings to the point where a 20 second exposure is less than one lateral cervical still exposure. A cervical motion study takes only about 15 to 20 seconds, therefore the exposure is actually less than a lateral cervical x-ray. (Based on a study by Peterson and Associates of Chicago, Illinois who are in the business of certifying radiological equipment for the health industry.)

Understanding Video Fluoroscopy

To better help you to understand the basic motion of the cervical spine, I have included a line drawing that shows where the motion of vertebral units should "pivot" around a particular point. In reality the X is the pivot point and the circle is the variation that is within normal limits. Anything out side this would be abnormal to the flexion and extension capabilities of the motion in the cervical spine.

Video fluoroscopy motion images of the cervical spine and X-rays can be used to judge the curvature of the spine by use of "George's Line" drawn on the posterior of the vertebral bodies and the pivot points around which a vertebral motor unit would normally move. (note drawing) It is also more desirable to have a 17CM curve from C-1 the Atlas to the anterior tip of T-2. Loss of the lordotic curvature can result in a condition known as a "military neck" (loss of forward curvature) and can pose problems to a person's ability to function normally. This condition requires a chiropractic analysis and when necessary conservative chiropractic adjustments to the affected area.

Dr. Christopher Kent wrote an extensive article on Research in Video Fluoroscopy in The Chiropractic Journal, November 1995, detailing 37 noted reports on research done on VF. One such study by Buonocare, Hartman and Nelson examined the cervical spines of 107 patients using cineradiography, including 57 who sustained flexion-extension injuries. They concluded, "The ability to demonstrate localized abnormal motion in the cervical spine allows one to predict soft-tissue injuries and the quality of spinal fusion, spinal stability, and early subluxation of the cervical spine -conditions that may not be identified on static roentgenograms nor at physical examination. (Buonocare E, Hartman JT, Nelson CL: "Cineradiograms of cervical spine in diagnosis of soft-tissue injuries." JAMA 198(1):143,1966.)

Dr. Wayne Henry Zemelka
3904 Lillie Ave. Suite #6 ~ Davenport, IA 52806
Tel: (563) 386-8585 drwayne@netins.net